Expanded criteria for video endoscopic inguinal lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes.

INTRODUCTION: Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. MATERIALS AND METHODS: The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). RESULTS: The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 x 53,2 years, operative time 126,8 x 95,5 minutes, hospital stay 5. x 3.1 days, drainage time 6.7 x 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% x 26%, cellulitis 4.5% x 0%, lymphocele 23% in both groups, skin necrosis 0% x 3%, myocutaneous necrosis 4.5% x 0%, pN+ 33% x 32 %, cancer specific mortality 7 % x 5 % and mean follow-up 17.3 x 35.3 months. None of the variables presented p < 0.05. CONCLUSIONS: VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN.

Laparoscopic radical prostatectomy for high risk localized and locally advanced disease.

PURPOSE: The indication for surgery in locally advanced prostate cancer is growing considering and long-term follow-up shows that 60-80% of patients can be free of clinical recurrence. The aim of this video is demonstrate the modifications in traditional laparoscopic surgery that permit to observe the oncological principles reproducing open surgery. MATERIALS AND METHODS: A 55 years-old male presented with an initial PSA = 25ng/dL, the digital rectal examination found a prostate with hardened nodules bilaterally (clinical stage T2c). Prostate biopsy showed an adenocarcinoma Gleason 7, the patient's disease was classified as a localized high-risk prostate cancer. Surgery was offered as initial therapeutic option and the critical technical points were: transperitoneal approach to evaluate if separation of rectum from prostate and seminal vesicles was possible, extended pelvic lymphadenectomy, opening of endopelvic fascia lateral to the prostate, bladder neck section without preservation, pedicle control without neurovascular bundle preservation, meticulous dissection of apical region, reconstruction of posterior bladder neck before the anastomosis. RESULTS: The operative time was 240 minutes without conversion to open surgery and an estimated blood loss around 520 mL. Neither intraoperative nor postoperative complications occurred and the hospital stay was about 36 hours. Pathological report confirmed a prostate adenocarcinoma Gleason 4+4, negative margins and stage pT3a pN0 pMx. CONCLUSIONS: Laparoscopic surgery adopting oncological principles can be utilized with efficacy to selected patients with high risk localized and locally advanced prostate cancer maintaining the advantages of minimally invasive surgical approach.

Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus.

Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.

Chemical composition and fatty acid profile of rhea (Rhea americana) meat.

The purpose of this work was to determine the proximate composition and fatty acid profiles of the Gastrocnemius pars interna intramuscular fat (IMF) of rhea (Rhea americana) thighs. The birds were bred in captivity, fed with balanced feed (Nutriavestruz Crescimento - Purina) and kept in a pen with grass ad lib. The birds of both sexes used in the research weighed 23 kg on average and were aged about twelve (12) months old. They were subjected to hydric diet (12 h) before slaughtering by electric shock. The rhea meat showed an average moisture, protein, ash and total lipid contents of 74.1%, 22.8%, 1.5% and 1.6%, respectively. It was noticed the predominance of monounsaturated fatty acids (MUFA) in intramuscular fat (IMF), 42.3% and a high percentage of polyunsaturated fatty acids (PUFA), 29.7%. The fatty acids found in higher proportion in rhea IMF were: 18:2n-6 (24.33%), 18: ln-9 (19.25%), 16:0 (13.70%), 22: ln9 (11.40%), 18:0 (10.66%), 15: ln-10 (8.62%), 24: ln-9 (2.90%) and 20:4n-6 (1.72%). The PUFA/SFA and n-6/n-3 ratios were 1.06 and 31.30, respectively. The consumption of rhea meat is a healthy alternative to red meat as it points to a lower susceptibility to cardiovascular diseases caused by the high consumption of fat comparatively to the consumption of meat from most domesticated animals.

Expanded criteria for Video Endoscopic Inguinal Lymphadenectomy (VEIL) in penile cancer: palpable lymph nodes

Introduction Open inguinal lymphadenectomy is the gold standard for the treatment of inguinal metastasis in patients with penile cancer (PC). Recently the Video Endoscopic Inguinal Lymphadenectomy (VEIL) was proposed as an option to reduce the morbidity of the procedure in patients without palpable inguinal lymph nodes (PILN), however the oncological equivalency in patients with PILN remains poorly studied. The aims of this video are the demonstration of VEIL in patients with PILN and present the preliminary experience comparing patients with and without PILN. Materials and Methods The video illustrates the procedure performed in two cases that were previously underwent partial penectomy for PC with PILN. Data from the series of 15 patients (22 limbs operated) with PILN underwent VEIL were compared with our series of VEIL in 25 clinically N0 patients (35 limbs operated). Results The comparison between the groups with and without PILN found, respectively, these outcomes: age 52,45 × 53,2 years, operative time 126,8 × 95,5 minutes, hospital stay 5. × 3.1 days, drainage time 6.7 × 5.7 days, 9 resected lymph nodes on average in both groups, global complications 32% × 26%, cellulitis 4.5% × 0%, lymphocele 23% in both groups, skin necrosis 0% × 3%, myocutaneous necrosis 4.5% × 0%, pN+ 33% × 32%, cancer specific mortality 7% × 5% and mean follow-up 17.3 × 35.3 months. None of the variables presented p < 0.05. Conclusions VEIL is a safe complementary procedure for treatment of PC, even in patients with PILN. Oncological results in patients with PILN seem to be appropriate but are still very premature. Prospective multicenter studies with larger samples and long-term follow-up should be conducted to determine the oncological equivalence of VEIL compared with open surgery in patients with PILN. .

Histórico e aspectos tecnológicos do processamento da linguiça cuiabana / Historical and technological aspects of the cuiabana sausage manufacturing procedure

O presente trabalho apresenta o aspecto histórico da linguiça cuiabana e os resultados da análise de suas características tecnológicas/sensoriais. Quatro formulações da linguiça tipo cuiabana foram processadas, variando-se a matéria-prima básica (carne bovina, frango, suína) utilizada. As matérias-primas (bovina,frango e suína) cortadas em cubos, assim como os demais ingredientes (alho, queijo, leite, pimenta e cebolinha) foram pesados e homogeneizados. A massa resultante foi refrigerada durante 24 horas para intensificar o sabor e, a seguir, embutida em tripas naturais. Nas amostras obtidas, foi realizada a caracterização do perfil físico-químico, avaliação ao longo de sete dias de armazenamento sob refrigeração por meio de análises microbiológicas de coliformes totais e termotolerantes (fecais), clostridrios sulfito redutores, Salmonella spp., Staphylococcus coagulase positiva, e de pH. Já o estudo de vida de prateleira sob refrigeração, ao longo de sete dias de armazenamento, foi efetuado por meio de análises microbiológicas para pesquisa de coliformes totais e termotolerantes (fecais), clostrídrios sulfito redutores, Salmonella spp, Staphylococcus coagulase positiva, e de pH. As amostras foram submetidas às análises sensorial e estatística das diferentes linguiças tipo cuiabana processadas em laboratório. As variações feitas, ao longo do tempo, na formulação das linguiças cuiabanas são fatores positivos, evidenciando que as alterações na formulação, como adição de queijo e mudanças nos tipos de carnes, são bem mais aceitas do que o produto original.

This paper reports the data on the cuiabana sausage historical aspect, and from the study performed on its technical/sensory characteristics. Four formulations of cuiabana-type sausage were prepared, varying the basic raw material (bovine, chicken and swine meats). For processing these sausages, the raw meats (beef, chicken and pork) were cut into cubes and together with the other ingredients (garlic, cheese, pepper and chives) they were weighed and homogenized. The resulting mixture was refrigerated for 24 hours for intensifying the flavor. Thereafter, it was stuffed into natural casings. These prepared samples were characterized on the physical-chemical profile and on the shelf life under refrigeration for over a seven day-storage in order to assess the microbiological contamination (total coliforms and fecal thermotolerant bacteria), sulphite-reducing clostridium, Salmonella spp., coagulase-positive Staphylococcus), and pH. The sensory evaluation and statistics analysis were carried out on the different types of laboratory- processed cuiabana sausage. Introducing over time changes in the cuiabana sausages formulation are positive factors; therefore, variations in the formulations it is feasible to get a better final product than that original one, and it might be resulted from the market demand.

Retroperitoneoscopy for treatment of renal and ureteral stones.

OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. CONCLUSION: Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

Chemical composition and fatty acid profile of rhea (Rhea americana) meat

The purpose of this work was to determine the proximate composition and fatty acid profiles of the Gastrocnemius pars interna intramuscular fat (IMF) of rhea (Rhea americana) thighs. The birds were bred in captivity, fed with balanced feed (Nutriavestruz Crescimento - Purina) and kept in a pen with grass ad lib. The birds of both sexes used in the research weighed 23 kg on average and were aged about twelve (12) months old. They were subjected to hydric diet (12 h) before slaughtering by electric shock. The rhea meat showed an average moisture, protein, ash and total lipid contents of 74.1%, 22.8%, 1.5% and 1.6%, respectively. It was noticed the predominance of monounsaturated fatty acids (MUFA) in intramuscular fat (IMF), 42.3% and a high percentage of polyunsaturated fatty acids (PUFA), 29.7%.. The fatty acids found in higher proportion in rhea IMF were: 18:2n-6 (24.33%), 18:1n-9 (19.25%), 16:0 (13.70%), 22:1n9 (11.40%), 18:0 (10.66%), 15:1n-10 (8.62%), 24:1n-9 (2.90%) and 20:4n-6 (1.72%). The PUFA/SFA and n-6/n-3 ratios were 1.06 and 31.30, respectively. The consumption of rhea meat is a healthy alternative to red meat as it points to a lower susceptibility to cardiovascular diseases caused by the high consumption of fat comparatively to the consumption of meat from most domesticated animals.

Composición química y perfil de ácidos grasos de la carne de ñandú (Rhea americana). El objetivo de este trabajo fue determinar la composición aproximada y el perfil de ácidos grasos en la carne de la parte intramuscular IMF) interna de la pierna de ñandú (Rhea americana). Las aves fueron criadas en cautiverio, alimentadas con ración balanceada (Nutriavestruz Crescimento - Purina) y mantenidas en corral con pasto ad lib. La edad media de las aves de los dos sexos usados en la investigación fue de 12 meses y el peso medio de 23 kg. Fueron sometidas a dieta hídrica por 12 horas antes de matarlas por aplicación de descarga eléctrica. Los resultados de contenido medio de humedad, proteína, cenizas y lípidos totales fue de 74.1%, 22.8%, 1.5% y 1.6%, respectivamente. Fue posible notar una predominancia de ácidos grasos monoinsaturados (MUFA) en la gordura intramuscular (IMF) ), 42.3% y un alto porcentaje de ácidos grasos poli-insaturados (PUFA), 29.7%. Los ácidos grasos encontrados en mayor proporción en rhea IMF fueron: 18:2n 6 (24.33%), 18:1n 9 (19.25%), 16:0 (13.70%), 22:1n9 (11.40%), 18:0 (10.66%), 15:1n 10 (8.62%), 24:1n 9 (2.90%) y 20:4n 6 (1.72%). La PUFA/SFA (ácidos grasos saturados) y relación n-6/ n-3 fue 1.06 y 31.30, respectivamente. El consumo de carne de ñandú es una alternativa saludable frente a la carne roja pues su consumo presenta una menor susceptibilidad a enfermedades cardiovasculares causadas por alto consumo de grasas cuando comparado con el consumo de carne de animales domesticados.

Qualidade microbiológica e físico-química de quibes crus comercializados em São José do Rio Preto, SP / Microbiological and physico-chemical raw meatballs commercialized in Sao Jose do Rio Preto, SP

As diversas etapas envolvidas na elaboração de quibe cru, quando não realizadas de maneira higiênico-sanitária adequada, podem se tornar potencial disseminador de micro-organismos patogênicos e deteriorantes, podendo alterar seus parâmetros físico-químicos. De acordo com o exposto o objetivo deste estudo foi verificar a qualidade microbiológica e físico-química de quibes crus comercializados em São José do Rio Preto, SP. Nas amostras analisadas, os resultados para clostrídios sulfito redutores, coliformes termotolerantes e Salmonella spp. apresentaram conformidade com a legislação, entretanto, para Staphylococus aureus (coagulase positiva) demonstraram valores superiores ao estabelecido (80,00%), sendo dessa forma recomendada a aplicação de treinamento aos manipuladores, bem como o emprego de Boas Práticas de Fabricação (BPF) e ainda, a higienização adequada de equipamentos e utensílios.

Retroperitoneoscopy for treatment of renal and ureteral stones

OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42 percent) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58 percent) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71 percent) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26 percent) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49 percent), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6 percent) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94 percent) became stone free. CONCLUSION: Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

Farinha de conchas dos moluscos escargot (Achatina fulica) e aruá (Pomacea lineata), como aproveitamento de resíduos / Shells of the molusks esgargot (Achatina fulica) and arua (Pomacea lineata) and recovery of waste

O objetivo deste trabalho foi estudar o aproveitamento das conchas dos moluscos escargot e aruá. As conchas foram processadas na forma de farinha e, depois, avaliadas suas características físico-químicas e microbiológicas. Essas características foram comparadas aos padrões de qualidade exigidos pela Lei 6.198, de 26/12/74, e o Decreto 76.986, de 06/01/76 do Ministério da Agricultura e Abastecimento, para a comercialização de produtos destinados à alimentação animal. Os resultados obtidos mostraram-se promissores, sendo o uso das conchas desses moluscos uma fonte alternativa de minerais para uso como fertilizantes e/ou na formulação de ração animal.

Jacaré do Pantanal (Caiman crocodilus yacare): rendimentos de abate e composiçäo da carne / Aligators of Pantanal (Caiman crocodilus yacare)

Um lote de 14 jacarés (Cayman crocodilus yacare) machos, nascidos e criados em Dourados MS, foi separado em dois grupos com base no peso corporal: I - regular (16,5-20,9kg), e II - leve (2,1-4,1kg). Fez-se o abate e a pesagem da carcaça e dos subprodutos e separou-se fisicamente as partes da carcaça (tronco, cauda e membros) em carne e osso. Amostras constituídas de carne do tronco e da cauda em partes iguais foram preparadas para determinaçöes químicas de umidade, proteínas totais e colágeno, lipídios totais e colesterol. O rendimento de carcaça foi menor no grupo regular, provavelmente em funçäo de maiores ímpetos de crescimento da pele e das vísceras relativamente aos tecidos muscular e conjuntivo. Os jacarés do grupo II, mais jovens e leves, tinham cerca de 3 pontos percentuais a mais de cauda do que os do grupo I, mais velhos e pesados. A relaçäo carne/osso do grupo I foi maior do que a do grupo II nas três partes consideradas. A carne tinha em sua composiçäo média, 75,2 - 78,2 por cento de umidade, 18,4 por cento de proteínas, 2,2 - 5,3 por cento de lipídios e 1,1 por cento de cinzas, sendo que a do grupo regular tinha maior proporçäo de colágeno, lipídios, e colesterol.